Abstract

Objective:

To determine if preterm birth is associated with adaptation of the hypothalamic–pituitary–adrenal (HPA) axis and whether HPA axis programming relates to the degree of prematurity (defined as extremely preterm birth at < 28 weeks or very preterm birth at 28–32 weeks gestation).

Design:

This study reports findings from a prospective birth cohort. Saliva cortisol concentrations were measured prevaccination and postvaccination, and in the morning and evening, at 4 months chronological age.

Setting:

Infants born at a single Scottish hospital.

Participants:

45 term-born, 42 very preterm and 16 extremely preterm infants.

Outcomes:

Cortisol stress response to vaccination (postvaccination minus prevaccination cortisol concentrations), diurnal slope (log-transformed morning minus log-transformed evening cortisol values) and mean log-transformed daily cortisol.

Results:

Compared with infants born at term, infants born extremely preterm had a blunted cortisol response to vaccination (5.8 nmol/L vs 13.1 nmol/L, difference in means: −7.3 nmol/L, 95% CI −14.0 to −0.6) and a flattened diurnal slope (difference in geometric means: −72.9%, 95% CI −87.1 to −42.8). In contrast, the cortisol response to vaccination (difference in means −2.7 nmol/L, 95% CI −7.4 to 2.0) and diurnal slope at 4 months (difference in geometric means: −33.6%, 95% CI −62.0 to 16.0) did not differ significantly in infants born very preterm compared with infants born at term.

Conclusions:

Infants born extremely preterm have blunted cortisol reactivity and a flattened diurnal slope. These patterns of HPA axis regulation are commonly seen after childhood adversity and could contribute to later metabolic and neurodevelopmental phenotypes observed in this population.

RAS ID

44317

Document Type

Journal Article

Date of Publication

8-2022

Funding Information

Theirworld

MRC Centre for Reproductive Health (MRC G1002033)

British Heart Foundation (RE/18/5/34216)

School

School of Nursing and Midwifery

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Publisher

BMJ Publishing Group

Comments

Stoye, D. Q., Boardman, J. P., Osmond, C., Sullivan, G., Lamb, G., Black, G. S., & Reynolds, R. M. (2022). Saliva cortisol diurnal variation and stress responses in term and preterm infants. Archives of Disease in Childhood: Fetal & Neonatal, 107(5), 565-567.

http://dx.doi.org/10.1136/archdischild-2021-321593

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Link to publisher version (DOI)

10.1136/archdischild-2021-321593